How to search the evidence

Dr Nadira A Albaghlie
 Source of evidence
 Primary literature
 EBM Secondary resource
Sources of primary literature
Medline
 Medline: produced by the national Library of Medicine
in Bethesda, Marylan
 the best-known bibliographic database of biomedical
journal literature which it index from 1966 on.
 Many ways exist to access to MEDLINE, and one of
the popular ones is Pub Med (http://
www.ncbi.nlm.nih.gov/entrez/query.fcgi//)
 not consider as the definitive source of medical
evidence
 33% to 49% of all clinical trials were not included in
MEDLINE
 pubMed
 pubMed is produced by national library of medicine in the USA
 The advantage:
 Up-todate: pre-Medline records are added to the database daily
before they are available on other commercially produced Medline
system
 Free
 Include additional features: access to full-text of freely available
journals
 Citation matchers: enable you to find references to articles when
you have incomplete details
 Clinical queries screen: provides short cut to searching for
evidence-based materials
Tips for search

 Boolean operator
 AND, OR, NOT
 Truncation with asterisk (*)
 “”
 EMBASE: EMBASE is the Excerpta Medical
database for biomedical and pharmaceutical
journal articles. This database indexes 3,500
journals. It is available since 1988, and is
searchable by a controlled vocabulary, it is
especially usefully useful for searching for
evidence regarding drugs and pharmaceuticals.
More information is available at
http://www.elsevier.com/inca/publications/store/5
/2/3/3/2/8/index.htt.
 CINAHL:
 Database of material related to nursing and the
other allied health disciplines. It is smaller than
Medline, with over 300,000 records from 600
journals, books, but it is much richer, including
the full text of articles and other materials such
as clinical practice guidelines. More information
including access can be found at
www.cinahl.com/.
 Full-text Online Journals:
 Access occasionally is free, but most often full
text requires subscription. A web site that
explains electronic journals and the issue
surrounding them, and that also provides a rich
source of the issues surrounding them, is:
http://library.kumc.edu/journals/onlinejnls.asp.
 Journals:
 A hand search of current journals in the field is
still one of the best ways to find newly published
information. But it is inefficient however, in that
articles on the topics of interest may be
published in medical journals other than these in
that discipline.
EBM secondary
resources
Evidence based abstraction
services
Best evidence
 www.acponline.org/catalog/electronic/best_e
 Annual cost: $ 85
 ACP journal club and evidence based
medicine
 Search 170 medical journals regularly to
identify original studies & systematic
review that are methodologically sound
&clinically relevant
 Structured Reviews
Cochrane library
 www.update-software.com/cochrane
 Annual cost :$225
 Focus primarily on systematic reviews of controlled trials of
therapeutic interventions
 Updated quarterly
 Contains 3 main sections:
 Cochrane database of systematic review (CDSR) include
complete reports for all the systematic review prepared by
members of the Cochrane collaboration
 The database of review of effectiveness (DARE) include
systematic review published outside collaboration
 The Cochrane controlled trials registry (CCTR)list of reference
of clinical trials that Cochrane investigators found by searching
 Text book
uptodate

 www.uptodate.com
 Annual cost: $495
 Well referenced online textbook updated
every 4 mos
 it is too large to print
 No explicit methodological quality criteria
 High quality studies chosen by authors
Clinical evidence

 www.evidence.org
 Annual cost:$ 115
 Six monthly
 Published by BMJ publishing group &
American college of physicians/
American society of internal medicine
Harrison’s online

 www.harrisonsonline.com
 Annual cost :$ 89
e-medicine

 www.emedicine.com
 free
medscape

 www.medscape.com/home/topics/homepage
 free
ScHARR netting the evidence

 www.shef.ac.uk/~scharr/ir/netting/
 free
bandolier

 http://www.jr2.ox.ac.uk/bandolier/
 free
Clinical practice guidelines

 Systematically developed statements to

assist practitioner and pt decisions about
appropriate health care for specific
clinical circumferences
 It is produced by associations,
foundations or other clinical groups
Clinical practice guidelines

 www.guidelines.gov
 www.cma.ca/cpgs
 free
National electronic library for
health (NHS)
 http://rms.nelh.nhs.uk/guidelinesfinder/
Scottish intercollegieat network guidelines
SIGN

 http://www.sign.ac.uk/guidelines/
National health & medical
research council (NHMRC)
Australia
 http://www.health.gov.au/cgi-
bin/htsearch
MD consult

 www.mdconsult.com
 Annual cost :$ 200
Turning research into practice
TRIP
Evidence based medicine reviews
OVID
 www.ovid.com/products/clinical/ebmr.cfm
 Annual cost $ 1995
 Combine several electronic databases
Cochrane database of systematic reviews,
best evidence, evidence based mental
health, cancerlit, evidence-based
nursing, healthstar, Medline, in addition
to link to over 200 full text journals
drsdesk

 http://drsdesk.sghms.ac.uk/
 make a links to full text evidence-based
medicine sources such as Bandolier,
Effective Matters and ACPOnline
Limitation of EBM
Limitation unique to practice of
EBM
 the need to develop skills in searching
and critical appraisal
 busy clinicians have limited times to
apply these skills
 the resources required for access to
evidence are usually inadequate in
clinical sitting.
Limitation universal to any practice
of science and medicine
 shortage of coherent consistent scientific
evidence;
 difficulties in applying any evidence to
the care of individual patients
 barriers to any practice of high quality
medicine.
pseudo limitations which arise from
misunderstanding of what EBM really
means
 it ignores clinical expertise
 ignores patients’ values
 promotes a cookbook approach to
medicine
 it is a cost-cutting tool